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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by jerryTRD on November 16, 2010, at 23:05:28
Diagnosis:
Major Depressive Disorder - Treatment resistant w/ Generalized anxiety disorder.Main complaints:
No motivation - cannot get out of bed
Extremely Lethargy
Decreased stamina, strength
Crying occasionally
Severe insomnia - takes 2-5 hours to get to sleep but then I just keep on sleeping.
Hopelessness
Low self-esteem
loneliness
Dysphoria
No joy from previously enjoyable hobbies, listening to music, etc
Severely decreased sex drive and sexual function. NOTHING turns me on.
Fleeting suicidal ideation from time to timeHAS HAD:
ECT treatments
Vegal Nerve Stimulator both failed.Now here's what I'm taking:
Lexapro 10mg
Effexor XR 150 - weaning off (although I had more sexual drive with the Effexor)
Adderall 20mg IR 3x daily
Klonopin 1mg 3x daily & 2 at bedtime
Seroquel 400mg at bedtime for sleep
Ambien 10mgSynthroid for under-active thyroid and after taking ti for 3 months has yet to help with depression and/or fatigue. Dosage increased today to 150mcg.
AndroGel - for low testosterone. Been on it a month and no help with sexual problems, libido, stamina, energy,
Problem:
Adderall 20mg IR 3x daily works great - but BIG crash about 2-3 hours after my last dose (3pm). Feel much more depressed due to the crash. But without the Adderall, I can't get out into life - participate in social activities, etc. It's just the crash!Insomnia - I've been on EVERYTHING for sleep -the best being Nembutal (a barbiturate) - gave me the BEST! sleep in my life!
I just want to feel naturally sleepy at night and not have my thoughts racing, etc.So you guys & gals - what would you do? change? swap out? remove entirely?
I have Medicare Part-D and Medicaid, but it usually won't cover off-label uses like memantine for stimulant crash.
SO WWYGD? (so what would you guys do?)
I desperately want to get a part-time job and I can't function like this - especially with the crash from Adderall IR (and no my ins doesn't cover the XR).
I'll take any and all suggestions -maybe there's a "solution" within your answers?
Thanks!
Jerry
Posted by Phillipa on November 16, 2010, at 23:18:15
In reply to I'll give you my symptoms, YOU Rx a med cocktail, posted by jerryTRD on November 16, 2010, at 23:05:28
From what I know and have learned from various doctors and caring for and having myself low thyroid seems to lead to harder to treat anxiety depression. I see 5mg of klonopin. Could you switch to another benzo as sometimes klonopin can be very depressing. I experienced this myself. Other than that I can't comment on the other meds. Phillipa
Posted by jerryTRD on November 17, 2010, at 0:32:37
In reply to Re: I'll give you my symptoms, YOU Rx a med cocktail » jerryTRD, posted by Phillipa on November 16, 2010, at 23:18:15
> From what I know and have learned from various doctors and caring for and having myself low thyroid seems to lead to harder to treat anxiety depression. I see 5mg of klonopin. Could you switch to another benzo as sometimes klonopin can be very depressing. I experienced this myself. Other than that I can't comment on the other meds. Phillipa
Yes as far as switching to another benzo. I'm going to ask my pdoc to switch me from klonopin to Ativan which works 10x better for me.
Posted by Jay_Clockwork_Angels on November 17, 2010, at 0:51:29
In reply to I'll give you my symptoms, YOU Rx a med cocktail, posted by jerryTRD on November 16, 2010, at 23:05:28
> Diagnosis:
> Major Depressive Disorder - Treatment resistant w/ Generalized anxiety disorder.
>
> Main complaints:
> No motivation - cannot get out of bed
> Extremely Lethargy
> Decreased stamina, strength
> Crying occasionally
> Severe insomnia - takes 2-5 hours to get to sleep but then I just keep on sleeping.
> Hopelessness
> Low self-esteem
> loneliness
> Dysphoria
> No joy from previously enjoyable hobbies, listening to music, etc
> Severely decreased sex drive and sexual function. NOTHING turns me on.
> Fleeting suicidal ideation from time to time
>
> HAS HAD:
>
> ECT treatments
> Vegal Nerve Stimulator both failed.
>
> Now here's what I'm taking:
>
> Lexapro 10mg
> Effexor XR 150 - weaning off (although I had more sexual drive with the Effexor)
> Adderall 20mg IR 3x daily
> Klonopin 1mg 3x daily & 2 at bedtime
> Seroquel 400mg at bedtime for sleep
> Ambien 10mg
>
> Synthroid for under-active thyroid and after taking ti for 3 months has yet to help with depression and/or fatigue. Dosage increased today to 150mcg.
>
> AndroGel - for low testosterone. Been on it a month and no help with sexual problems, libido, stamina, energy,
>
> Problem:
> Adderall 20mg IR 3x daily works great - but BIG crash about 2-3 hours after my last dose (3pm). Feel much more depressed due to the crash. But without the Adderall, I can't get out into life - participate in social activities, etc. It's just the crash!
>
> Insomnia - I've been on EVERYTHING for sleep -the best being Nembutal (a barbiturate) - gave me the BEST! sleep in my life!
> I just want to feel naturally sleepy at night and not have my thoughts racing, etc.
>
> So you guys & gals - what would you do? change? swap out? remove entirely?
>
> I have Medicare Part-D and Medicaid, but it usually won't cover off-label uses like memantine for stimulant crash.
>
> SO WWYGD? (so what would you guys do?)
>
> I desperately want to get a part-time job and I can't function like this - especially with the crash from Adderall IR (and no my ins doesn't cover the XR).
>
> I'll take any and all suggestions -maybe there's a "solution" within your answers?
>
> Thanks!
> Jerry
>Hey Jerry,
I am just tossing some ideas since we seem to be similar in some symptoms. There are a few different avenues you can take, but I might suggest that you are in need of some more GABA and serotonin-acting meds. This is just my quite mild guess, of course..so YMMV, etc..lol.
There are a couple of meds that unfortunately are very expensive but newer. And no, these are no magical cure either...but I know that you know that.
First, I'd say add a small amount of both Lyrica and Abilify. I know antipsychotics are no *miracle*, but I have found them best taken with an anti-histamine anti-cholenergic drug as simple as Benadryl, daily.
Lyrica feels a lot more 'consistent' than Neurontin,(IMHO) but again, costs quite a bit.
What I am thinking is Abilify seems to have a positive effect on dopamine, increasing or decreasing it, and Lyrica will help work alongside the clonazepam you take. I found Lyrica to be one of the most important drugs in my pill regime. Abilify may also decrease your need for Adderall, for the sake of preventing your dopamine ups and downs so much.
The Androgel, I have found it honestly to have a very, very subtle effect which seems to come around about the 2 month mark. I know, waiting again...sucks..lol. With the other meds, it seems to have a synergistic effect. But, it's not like I am getting massive erections constantly every day. But, if I let a sweet gal take control of my zipper, then things come alive!! lol. Also, this may not be noticeable, but the Androgel helps replace your body's fat with lean muscle. Muscle also weighs more than fat, so after a few months, try on a smaller waist size pants, and even if your scale doesn't show much, you will be able to tell with the waist measurement.
Oh ya, and also, I have found two 5mg packets of Androgel works better than one 5mg packet. See, what is happening is the Androgel is a complete *replacement* of your testosterone. First, it decreases your body's natural testosterone, but then needs a few months to build up the Androgel.
PHEW..okay, I touched on a few things, what do you think?
Take care,
Jay
Posted by jerryTRD on November 17, 2010, at 0:59:58
In reply to Re: I'll give you my symptoms, YOU Rx a med cocktail » jerryTRD, posted by Jay_Clockwork_Angels on November 17, 2010, at 0:51:29
> > Diagnosis:
> > Major Depressive Disorder - Treatment resistant w/ Generalized anxiety disorder.
> >
> > Main complaints:
> > No motivation - cannot get out of bed
> > Extremely Lethargy
> > Decreased stamina, strength
> > Crying occasionally
> > Severe insomnia - takes 2-5 hours to get to sleep but then I just keep on sleeping.
> > Hopelessness
> > Low self-esteem
> > loneliness
> > Dysphoria
> > No joy from previously enjoyable hobbies, listening to music, etc
> > Severely decreased sex drive and sexual function. NOTHING turns me on.
> > Fleeting suicidal ideation from time to time
> >
> > HAS HAD:
> >
> > ECT treatments
> > Vegal Nerve Stimulator both failed.
> >
> > Now here's what I'm taking:
> >
> > Lexapro 10mg
> > Effexor XR 150 - weaning off (although I had more sexual drive with the Effexor)
> > Adderall 20mg IR 3x daily
> > Klonopin 1mg 3x daily & 2 at bedtime
> > Seroquel 400mg at bedtime for sleep
> > Ambien 10mg
> >
> > Synthroid for under-active thyroid and after taking ti for 3 months has yet to help with depression and/or fatigue. Dosage increased today to 150mcg.
> >
> > AndroGel - for low testosterone. Been on it a month and no help with sexual problems, libido, stamina, energy,
> >
> > Problem:
> > Adderall 20mg IR 3x daily works great - but BIG crash about 2-3 hours after my last dose (3pm). Feel much more depressed due to the crash. But without the Adderall, I can't get out into life - participate in social activities, etc. It's just the crash!
> >
> > Insomnia - I've been on EVERYTHING for sleep -the best being Nembutal (a barbiturate) - gave me the BEST! sleep in my life!
> > I just want to feel naturally sleepy at night and not have my thoughts racing, etc.
> >
> > So you guys & gals - what would you do? change? swap out? remove entirely?
> >
> > I have Medicare Part-D and Medicaid, but it usually won't cover off-label uses like memantine for stimulant crash.
> >
> > SO WWYGD? (so what would you guys do?)
> >
> > I desperately want to get a part-time job and I can't function like this - especially with the crash from Adderall IR (and no my ins doesn't cover the XR).
> >
> > I'll take any and all suggestions -maybe there's a "solution" within your answers?
> >
> > Thanks!
> > Jerry
> >
>
> Hey Jerry,
>
> I am just tossing some ideas since we seem to be similar in some symptoms. There are a few different avenues you can take, but I might suggest that you are in need of some more GABA and serotonin-acting meds. This is just my quite mild guess, of course..so YMMV, etc..lol.
>
> There are a couple of meds that unfortunately are very expensive but newer. And no, these are no magical cure either...but I know that you know that.
>
> First, I'd say add a small amount of both Lyrica and Abilify. I know antipsychotics are no *miracle*, but I have found them best taken with an anti-histamine anti-cholenergic drug as simple as Benadryl, daily.
>
> Lyrica feels a lot more 'consistent' than Neurontin,(IMHO) but again, costs quite a bit.
>
> What I am thinking is Abilify seems to have a positive effect on dopamine, increasing or decreasing it, and Lyrica will help work alongside the clonazepam you take. I found Lyrica to be one of the most important drugs in my pill regime. Abilify may also decrease your need for Adderall, for the sake of preventing your dopamine ups and downs so much.
>
> The Androgel, I have found it honestly to have a very, very subtle effect which seems to come around about the 2 month mark. I know, waiting again...sucks..lol. With the other meds, it seems to have a synergistic effect. But, it's not like I am getting massive erections constantly every day. But, if I let a sweet gal take control of my zipper, then things come alive!! lol. Also, this may not be noticeable, but the Androgel helps replace your body's fat with lean muscle. Muscle also weighs more than fat, so after a few months, try on a smaller waist size pants, and even if your scale doesn't show much, you will be able to tell with the waist measurement.
>
> Oh ya, and also, I have found two 5mg packets of Androgel works better than one 5mg packet. See, what is happening is the Androgel is a complete *replacement* of your testosterone. First, it decreases your body's natural testosterone, but then needs a few months to build up the Androgel.
>
> PHEW..okay, I touched on a few things, what do you think?
>
> Take care,
> Jay
>
>
>
>
Hey jayI appreciate you replying. I'll take a look more close;y tomorrow - cause it's way past my "bedtime."
Along with your suggestions - I feel my reward system is malfunctioning. 7 Years ago when I live din Minneapolis I saw a team of high ranking pdocs and they finally agrees to augment my current meds with hydrocodone. This went on for 3 years or so until I moved home - well I shouldn't say that because when i saw my pdoc here (my hometown) he read the note from the U of MN pdos on why I was on the hydrocodone and he had no problems prescribing it. it helped SOOOOOOOOO MUCH!!!!!
I never abused it nor did I ever become tolerant to it.
However about a year or so ago my pdoc just decide to take me off of it because they stopped making the brand I was on (stupid reason) but I think my pdoc was a bit nervous with me on it especially being the only pdoc in our town.
BUt hell I dunno if I'll even see another pdoc who would be willing to add the hydrocodone back into my mix.
Posted by Tomatheus on November 17, 2010, at 10:50:10
In reply to I'll give you my symptoms, YOU Rx a med cocktail, posted by jerryTRD on November 16, 2010, at 23:05:28
Jerry,
Of the antidepressants that I tried, I had the most success with the MAOIs (particularly Nardil) when it came to my issues with energy, motivation, and anhedonia. Unfortunately, I never have been able to get a truly long-lasting response out of any antidepressant that I've tried, but your case may be different. I think that you may find an MAOI to be helpful for some of your symptoms, but MAOIs are also known to exacerbate insomnia, so that's something that you'd definitely want to take into consideration. Another medication that you may want to look into is Abilify. I found that after I started taking Abilify that it became much easier to get out of bed than it was before I started the medication. I also felt more energetic during the day after I started the Abilify, although I also noticed that I felt more apathetic than usual after I started it. So, I think that you may find Abilify helpful when it comes to your lethargy and stamina issues and also when it comes to getting out of bed in the morning.
Well, I don't have much else to suggest beyond looking into trying an MAOI and/or Abilify if you haven't already. I hope that you find some of the ideas on this thread to be helpful. It would be great if some of the suggestions could open up some new treatment avenues for you. Good luck getting the advice that you need and finding a combination of medications that brings you relief.
Tomatheus
Posted by Phidippus on November 17, 2010, at 22:13:34
In reply to I'll give you my symptoms, YOU Rx a med cocktail, posted by jerryTRD on November 16, 2010, at 23:05:28
>Lexapro 10mg
Switch to Amitryptaline or Clomipramine. Both are better mood brighteners.
>Effexor XR 150 - weaning off (although I had >more sexual drive with the Effexor)
Effexor stimulates dopamine, which probably helped your libido. This is also a very low dose. Try Remeron 30-45mg
>Adderall 20mg IR 3x daily
.Vyvanse is better
>Klonopin 1mg 3x daily & 2 at bedtime
Klonopin lowers shta in the brain and can cause depression. Switch to Valium or try Gabapentin, Gabitril or Lyrica for anxiety
>Seroquel 400mg at bedtime for sleep
Seroquel can make you feel really groggy, which can feel depressing. Try Cyproheptadine instead.
>Ambien 10mg
You won't need it if you switch the anxiety meds around or try cyproheptadien
p
Posted by jerryTRD on November 17, 2010, at 22:54:19
In reply to Re: I'll give you my symptoms, YOU Rx a med cocktail » jerryTRD, posted by Phidippus on November 17, 2010, at 22:13:34
> >Lexapro 10mg
>
> Switch to Amitryptaline or Clomipramine. Both are better mood brighteners.
>
> >Effexor XR 150 - weaning off (although I had >more sexual drive with the Effexor)
>
> Effexor stimulates dopamine, which probably helped your libido. This is also a very low dose. Try Remeron 30-45mg
>
> >Adderall 20mg IR 3x daily
>
> .Vyvanse is better
>
> >Klonopin 1mg 3x daily & 2 at bedtime
>
> Klonopin lowers shta in the brain and can cause depression. Switch to Valium or try Gabapentin, Gabitril or Lyrica for anxiety
>
> >Seroquel 400mg at bedtime for sleep
>
> Seroquel can make you feel really groggy, which can feel depressing. Try Cyproheptadine instead.
>
> >Ambien 10mg
>
> You won't need it if you switch the anxiety meds around or try cyproheptadien
> p
>Very good on your comments and suggestions - but Cyproheptadine is a serotonin agonist or anti-serotonin - a pretty strong one at that. They gave that to me IV when I had a severe serotonin syndrome (body wouldn't stop violently shaking, sweating - almost had kidney failure because I combined dextromethorphan with Nardil). Wouldn't that hinder actions of the other meds you suggest?
Posted by Phillipa on November 17, 2010, at 23:56:03
In reply to Re: I'll give you my symptoms, YOU Rx a med cocktail » Phidippus, posted by jerryTRD on November 17, 2010, at 22:54:19
Jerry Serotonin syndrome from Nardil? Wow. So sorry. Hoping won't happen to me pdoc said no as she said take 7.5 lexapro and 50mg luvox. Phillipa
Posted by jerrytrd on November 18, 2010, at 0:15:17
In reply to Re: I'll give you my symptoms, YOU Rx a med cocktail » jerryTRD, posted by Phillipa on November 17, 2010, at 23:56:03
Just don't take ANY OTC cough or cold formulations> Jerry Serotonin syndrome from Nardil? Wow. So sorry. Hoping won't happen to me pdoc said no as she said take 7.5 lexapro and 50mg luvox. Phillipa
Posted by ed_uk2010 on November 19, 2010, at 16:16:53
In reply to I'll give you my symptoms, YOU Rx a med cocktail, posted by jerryTRD on November 16, 2010, at 23:05:28
> Lexapro 10mg
> Effexor XR 150 - weaning off (although I had more sexual drive with the Effexor)
> Adderall 20mg IR 3x daily
> Klonopin 1mg 3x daily & 2 at bedtime
> Seroquel 400mg at bedtime for sleep
> Ambien 10mgHi Jerry,
I'm sorry that you're suffering so much at the moment. Your benzo/sedative doses are high and I suspect that they may impair the effectiveness of your antidepressants. Long term use of sedative drugs at high doses is often detrimental in chronic insomnia and depression. It's a difficult situation.
I think you should focus on stopping Ambien and reducing your benzo doses down to the absolute minimum. Ambien is not recommended for long term use and can itself cause psychiatric adverse effects. In addition, your Seroquel dose is high and I think it might help to reduce it a little.
So....your combo could be...
Lexapro 10mg
Adderall - lowest possible daily dose. Be careful to avoid doses late in the day which could interfere with sleep
Seroquel - max. 300mg. Taper off and try 25mg of Phenergan if you prefer. Phenergan is best taken no later than 9pm or else it is likely to cause daytime drowsiness and fatigue.
Ambien - preferably none - otherwise 10mg
Benzo - which ever benzo causes you the least depression - lowest possible daily dose with the largest dose at night
I do not think the Androgel will improve your libido if you continue on your current medication. With fewer sedatives on board, I expect you will notice an improvement in sexual function.
Best,
ed
Posted by Brainbeard on November 26, 2010, at 10:50:20
In reply to Re: I'll give you my symptoms, YOU Rx a med cocktail » Phidippus, posted by jerryTRD on November 17, 2010, at 22:54:19
> Cyproheptadine is a serotonin agonist or anti-serotonin - a pretty strong one at that. (.....) Wouldn't that hinder actions of the other meds you suggest?
It probably would. Cyproheptadine has been investigated as an add-on to SRIs for countering SRI induced sexual dysfunction and/or excessive sweating, but when used long(er) term, it also countered antidepressant efficacy.
This is the end of the thread.
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